What is the Current State of Healthcare in America?
The American healthcare system is broken. Even though the US spends twice as much on healthcare per-capita than other nations, it ranks 51st out of 220 countries in average life expectancy. There is a 30% waste factor in US healthcare expenditures, equating to just under 1 trillion dollars. And, even more shocking, this expenditure does not take into account the approximately 49 million people - nearly 20% of the entire population - who remain uninsured.
All of this is putting upward pressure on health insurance costs for businesses, forcing many employers to offer reduced health benefits at a higher price. In the face of these challenges, businesses are looking for new options.
What are Defined Contribution Health Benefits?
With a defined contribution plan, employers are able to pass control of healthcare spending and decision making to their employees. Often referred to as “consumer directed healthcare benefits,” in a defined contribution plan, employees are given a set amount to spend on major medical insurance and additional health benefits, with which they can choose the health and benefit plan options that are right for them.
Defined contribution plans help employers infuse predictability and cost control into their healthcare expenditures and provide employees more flexibility and control over their healthcare choices.
What Do I Need to Know about the Affordable Care Act (ACA)?
In March of 2010, President Obama signed into law the Patient Protection and Affordable Care Act, (aka the ACA or “Obamacare”). The overarching goal of the ACA is to reduce the number of Americans without health insurance by offering government-incentivized (and in some cases subsidized) health insurance that can be purchased through state or federally-run Public Exchanges.
Two main provisions of the Act are the employer and the individual mandates. Under the ACA, employers with 50 or more full-time workers must offer health insurance that meets standards of quality and affordability by January 1st of 2015 or pay a $2,000-per-employee annual penalty. The Act also requires employers to provide detailed reporting on their health benefits plans. On an individual level, the ACA requires that virtually everyone in US be enrolled in or covered by at least a minimum benefit set healthcare plan.
What is a Public Healthcare Exchange?
Under the Affordable Care Act, beginning in 2014, individuals and small businesses (defined as a company having at least one employee on the first day of the plan year, but no more than 100 employees during the preceding calendar year) will be able to purchase health insurance through federally mandated, state-run health insurance exchanges. State exchanges must be established and ready to accept enrollees by October 1, 2013.
The public exchanges will offer standardized health plans (referred to as qualified health plans, or QHPs) that provide different levels of coverage for “essential health benefits.” People without access to affordable healthcare through their employer may qualify for subsidies in the form of premium tax credits and cost-sharing reductions. To qualify, however, a person’s federal income must be under four times the federal poverty level.
The exchange for individual coverage will operate separately from the small employer exchange, referred to as the Small Business Health Options program, or SHOP.
Are There Private Alternatives?
As an alternative to state-run public exchanges, many industry stakeholders are setting up private exchanges, or marketplaces of health insurance and other benefits. Employers can purchase health insurance through one of these privately run exchanges; their employees select a major medical plan from the particular payers offered through the exchange, as well as any number of other benefits on offer.
Private exchanges generally provide more flexibility of health plan offerings than their public counterparts. They can be customized to address the needs of any-size employer group, and typically offer a broader range of retail products than the public exchanges.
CieloStar’s CieloChoice Fully Integrated Health and Benefits System is one such example of a private exchange.
What is CieloChoice?
CieloChoice is CieloStar’s Fully Integrated Health and Benefits System that enables employers, affinity groups, brokers, third-party administrators and associations to offer private exchanges and defined contribution benefit solutions to their employees, clients and member organizations.
Is It Easy to Enroll with CieloChoice?
CieloStar has formed unique relationships with a number of leading national and regional health and benefits insurance providers to offer employers a wide selection of benefit plans through the CieloChoice platform to meet virtually every employee need.
Regardless of whether you want to offer your employees’ major medical plans only, or medical plus all of the other benefits available with CieloChoice, the process is quick and easy. In just a few steps, you will be able to choose a benefit plan for your employees, upload their demographic information for self-service enrollment, choose plans and contribution amounts, and create your employer profile for billing and reporting access.
Here’s the best part: all of the steps in the CieloChoice health and benefits enrollment process are self-service and automated.
Once I Enroll, How will I be Billed?
In the final step of the enrollment process, you will designate an account for all chosen plan coverage monthly premiums to be deducted via ACH. As an administrator, you will be able to download a premium review report from CieloChoice that will assist you in determining employee contribution amounts for any coverage you decide to contribute to.
How Soon Can I Enroll with CieloChoice?
The CieloChoice Fully Integrated Health and Benefits System will begin taking online applications on the first day of Open Enrollment, October 1st, 2013.